Retrosternal goiters

Clinica 1 Chirurgie, Clinica de Endocrinologie, Spitalul „Sf.Spiridon”, UMF ”Gr.T.Popa”, Iaşi, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Noțiunea de guşă retrosternală sau substernală reprezintă coborîrea a mai mult de 50% de glanda tiroidă în cavitatea toracică. Material şi metode: A fost efectuat un studiu retrospectiv a cazurilor de guşă retrosternală sau substernală din totalul de 2482 pacienți ce au suportat tiroidectomie în Clinica 1 Chirurgie din Iaşi în perioada 2000-2010. Guşa retrosternală a fost depistată la 54 (2,17%) pacienți. Toți bolnavii au fost îndreptați la operație din Clinica de Endocrinologie. Rezultate: Vîrsta medie a pacienților la momentul instalării diagnosticului a constituit 55,3±3,58 ani, majoritatea fiind femei – 83,3%. În manifestările clinice ale guşei retrosternale au dominat fenomenele de compresie. Dereglările funcției glandei tiroide au fost determinate prin teste hormonale efectuate în Clinica de Endocrinologie în 15 (27,7%) cazuri. Diagnoza de guşă retrosternală a fost suspectată în baza examenului clinic şi confirmată imagistic: radiografie toracică, ultrasonografie, computer tomografie. Abordul cervical a fost utilizat cu siguranță, sternotomia fiind necesară doar în 8 (14,8%) cazuri. Morbiditatea postoperatorie a constituit 5,5% (3 cazuri) cu mortalitate nulă. Durata medie de spitalizare a fost 4,3 zile. Noi am comparat datele noastre recente cu raportul privind tratamentul guşei retrosternale şi toracice în Clinica 1 Chirurgie din Iaşi în perioada anilor 1950-1979, publicat în revista „Chirurgia” în 1981. Concluzii: Guşa retrosternală reprezintă o formă specifică de patologie a glandei tiroide cu o incidență scăzută. Diagnosticul şi tratamentul guşei retrosternale implică o abordare multidisciplinară. Medicul endocrinolog are un rol important în diagnosticul şi supravegherea postoperatorie. Deşi intervenția chirurgicală este o metoda curativă de elecție pentru guşa substernală, persistă controverse privind abordul chirurgical şi rata complicațiilor. Abordul cervical poate fi utilizat cu siguranță aproape în toate cazurile, sternotomia fiind efectuată fără ezitare în caz de necesitate.Introduction: The term of retrosternal or substernal goiter means that more than 50% of thyroid gland descends in the thorax. Material and methods: There is a retrospective study on retrosternal and substernal goiter and its pathological features among 2482 patients who underwent thyroidectomy between 2000 and 2010 in the First Surgery Clinic of Iasi. Retrosternal goiter was diagnosed in 54 (2.17%) patients. All patients were referred to surgery from the Clinic of Endocrinology. Results: Mean age at diagnosis was 55.3±3.58 years, and most cases were found in women – 83.3%). The clinical picture of retrosternal goiter was dominated by compressive disorders. Thyroid function abnormalities were identified by hormonal assays performed on Endocrinology Clinic Iasi in 15 (27.7%) cases. The diagnosis of retrosternal goiter was suggested by clinical examination and confirmed by imaging: chest X-ray, ultrasound, CT scan. The cervical approach was safely performed. Only in 8 cases (14.8%), sternotomy was necessary. There was no mortality, and morbidity was 5.5% (3 cases). The length of stay in the hospital was 4.3 days. We compared our recent data with a previous report on retrosternal and thoracic goiter treated in First Surgery Clinic of Iasi during 1950 to 1979 and published in the journal “Chirurgia” in 1981. Conclusions: Retrosternal goiter is a particular form of thyroid surgical pathology presented with reduced incidence. Diagnosis and treatment of retrosternal goiter involve a multidisciplinary team. The endocrinologist has an important role in diagnosis and postoperative follow-up. Surgery is the treatment of choice for substernal goiters, but there are still some controversies on surgical approach, and complication rate. The cervical approach can be safely performed in almost all cases but when required, sternotomy should be performed without hesitation

Cystic abdominal lymphangioma – laparoscopic approach

Clinica I Chirurgie, Clinica Universitară „Sf.Spiridon”, Universitatea de Medicină şi Farmacie „Gr.T.Popa”, Iaşi, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Limfangioamele chistice (LC) sunt tumori benigne rare de origine limfatică (anomalie vasculară congenitală). Cea mai frecventă localizare este regiunea craniană – faţa şi gâtul (75% - higromă chistică), regiunea axilară şi mediastinul (20%) şi 5% - alte locaţii. LC retroperitoneale reprezintă <1% dintre cazuri. Material și metode: Noi raportăm o serie din 7 cazuri de LC abdominale operate prin abord laparoscopic din 17 LC operate în ultimii 10 ani în Clinica I Chirurgie, Clinica Universitară „Sf.Spiridon”. Rezultate: Raportul femei/bărbaţi a fost de 6/1,cu vârstă medie de 35,6 ani (20-51 ani). Simptomele principale au fost durerea, distensia abdominală şi prezenţa unei formaţiuni abdominale palpabile. Pacienţii au fost supuşi examenului clinic, ultrasonografic şi CT. Diagnosticul de LC a fost suspectat preoperator numai în 3 cazuri. Explorarea laparoscopică a pus în evidenţă existenţa tumorilor retroperitoneale numai în 2 cazuri, în mezenter, în omentul mare şi mezocolon pe dreapta – cîte un caz fiecare. Noi am recurs la excizia laparoscopică a chistului cu evoluţie postoperatorie favorabilă. Dimensiunea medie a tumorii a fost de 11,4 cm. Durata medie de spitalizare a fost de 3,4 zile. Concluzii: Abordul laparoscopic este fezabil (“standardul de aur”), stabileşte diagnosticul şi permite excizia chirurgicală completă, ceea ce diminuează riscul de recidive.Introduction: Cystic lymphangioamas (CL) are rare benign tumors, with lymphatic origin (congenital vascular anomaly). It locates the most frequent cranial region – face and neck (75% - cystic hygroma), mediastinum and axilla (20%) and 5% other locations. CL retroperitoneal represents <1% of cases. Material and methods: We report a series of 7 cases of abdominal CL operated by laparoscopic approach from 17 CL operated in last 10 years in the First Surgical Clinic, “St.Spiridon” Hospital. Results: The ratio female/male was 6/1, with a mean age of 35.6 years (20-51 years). The main symptoms were pain, abdominal distension and palpable abdominal mass. Patients were examined clinically, ultrasound and CT. The diagnosis of CL was suspected preoperatively only in 3 cases. Laparoscopic exploration reveals the existence of retroperitoneal tumor in 2 cases, in mesentery, in great omentum and in right mesocolon in 1 case each. We performed laparoscopic excision of the cyst with favorable postoperative course. Mean tumor size was 11.4 cm. Mean hospital stay was 3.4 days. Conclusions: Laparoscopic approach is feasible (gold standard), certified diagnosis and allows complete surgical excision, which reduces the risk of relapse

High-quality polarization entanglement state preparation and manipulation in standard telecommunication channels

We report a novel and simple approach for generating near-perfect quality polarization entanglement in a fully guided-wave fashion. Both deterministic pair separation into two adjacent telecommunication channels and the paired photons' temporal walk-off compensation are achieved using standard fiber components. Two-photon interference experiments are performed, both for quantitatively demonstrating the relevance of our approach, and for manipulating the produced state between bosonic and fermionic symmetries. The compactness, versatility, and reliability of this configuration makes it a potential candidate for quantum communication applications.Comment: 6 figure

Laparoscopy for abdominal emergencies

Clinica I Chirurgie, Clinica Universitară „Sf.Spiridon”, Universitatea de Medicină și Farmacie „Gr.T.Popa”, Iași, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: În patologia abdomenului acut laparoscopia are multiple scopuri: stabilirea sau confirmarea diagnosticului, tratarea patologiilor și identificarea acelor pacienți care necesită tratament chirurgical.Material și metode: Scopul acestui studiu retrospectiv a constat în evaluarea rezultatelor experienței noastre laparoscopice în patologiile abdomenului acut, în perioada anilor 1993-2013; timp în care am efectuat peste 15.000 de intervenții laparoscopice. Rezultate: În studiul de față noi prezentăm analiza datelor a 3.785 pacienți internați în Clinică cu diagnosticul de abdomen acut: ulcer peptic perforat – 54 cazuri, trauma abdominală – 44 cazuri, infarct intestinal – 12 cazuri, ocluzie intestinală – 12 cazuri, apendicită acută – 1.332 cazuri, patologie acută a anexelor – 54 cazuri, colecistită acută – 2.251 cazuri, pancreatită acută – 9 cazuri, abcese abdominale – 12 cazuri, abdomen acut fals – 5 cazuri. Toți pacienții au fost supuși intervenției chirurgicale laparoscopice de urgență. Operația a fost realizată integral prin abord laparoscopic în 3.217 cazuri (85%), în timp ce conversia spre laparotomie a fost necesară în 568 cazuri (15%, numai 6% pentru abdomen acut non-traumatic). Morbiditatea în cazul intervențiilor realizate integral pe cale laparoscopică a fost 2,2%; mortalitatea – 0,3%; iar perioada medie de spitalizare a fost de 5 zile. Concluzii: Experiența noastră arată în mod clar posibilitatea de a combina o procedură de diagnosticare cu una curativă și indică asupra fezabilității și siguranței laparoscopiei în chirurgia de urgență. Laparotomia negativă se poate asocia cu o an umită rată de complicații, în timp ce laparoscopia pare a fi o modalitate de valoare pentru a îmbunătăți acuratețea diagnosticului sindromului algic în abdomenul acut și a oferi modalități promițătoare de tratament. Cu toate acestea, chirurgia laparoscopic ă de urgență este încă o procedură dificilă sub aspect tehnic, care necesită a fi efectuată de către o echipă specializată.Introduction: In acute abdominal disorders laparoscopy has a multiple goals: to establish or to confirm diagnosis; treating the disorders and identifies those patients who do not need surgery. Material and methods: The purpose of this retrospective study is to evaluate the results of our experience in laparoscopy for acute abdominal disorders, between 1993-2013, when we performed over 15.000 laparoscopic interventions. Results: In the present study we report on 3.785 patients admitted to hospital, with a diagnosis of acute abdominal disorders: perforated peptic ulcer – 54 cases, abdominal trauma – 44 cases, intestinal infarction – 12 cases, intestinal obstruction – 12 cases, acute appendicitis – 1.332 cases, acute adnexal pathologies – 54 cases, acute cholecystitis – 2.251 cases, acute pancreatitis – 9 cases, abdominal abscesses – 12 cases, false acute abdomen – 5 cases. All patients were submitted to emergency laparoscopic surgery. The operation was completed laparoscopically in 3.217 cases (85%), while conversion to laparotomy proved necessary in 568 cases (15%, only 6% - for non-traumatic acute abdomen). The morbidity of the cases completed laparoscopically was 2.2%; the mortality – 0.3%, and the mean hospital stay – 5 days. Conclusions: Our experience shows clearly both diagnostic and curative values of laparoscopy; suggests the feasibility and safety of the laparoscopy in emergency surgery. A negative laparotomy may have complications, while laparoscopy appears to be a valuable way to improve the accuracy of diagnosis of acute abdominal pain and offers a promising modality of treatment. Nevertheless, emergency laparoscopic surgery is still a technically difficult procedure that needs to be performed by an experienced surgical team

Fondurile cinegetice ale Universității ”Ștefan cel Mare” Suceava – Facultatea de Silvicultură: o retrospectivă a activității [Hunting Funds of Ștefan cel Mare University of Suceava - Faculty of Forestry: a retrospective of work]

Ștefan cel Mare University’s Hunting Funds, through the Faculty of Forestry, consists of three hunting territories (HT): HT no. 55 Mitoc, HT no. 69 Râșca, HT no. 56 Salcea. The first two have a high hunting potential for major hunting sedentary game species (wild boar, roe buck, roe deer, hare, wolf, bear). In over 15 years of hunting management, USV has overcome the difficulties imposed by different legislations. Also, USV, along with the University of Brașov, managed to amend Law 407/2006 and to return to free hunting use of the public lands. The teaching and research activities in the hunting territories have resulted in over 15 diploma projects, over 20 scientific articles published in specialized reviews, of which 7 ISI, over 10 scientific papers of which two were the students’ work, two research contracts and a book. The management coherence driven by the specialized staff is reflected in the higher number of top quality trophies, which started to be harvested after about 10 years of management

Ungulate browsing causes species loss in deciduous forests independent of community dynamics and silvicultural management in Central and Southeastern Europe

Grid-based inventories of 1,924 deciduous forests plots in Germany and 4,775 in Romania were used to investigate tree species composition as affected by browsing and grazing under different forest management (rotation forestry, selectively cut forest, protected forest). At regional scale, the loss of tree species in the dominant layer was between 52 to 67% in Germany and of 10 to 30% in Romania, with largest effects in protected nature reserves in Germany. At plot level, only 50% (Germany) to 54% (Romania) of canopy species were found in the regeneration layer with a height of 1.5 m. Browsing was influenced by the proportion of Fagus in the regenerating trees in Germany, and by stand density, basal area, and management in both regions. Structural equation modeling explained 11 to 26% of the variance in species loss based on the fresh loss of the terminal bud in the winter prior to the inventory work (one season browsing). Browsing (and grazing in Romania) is shown to be a significant cause of species loss across both countries and all management types. Potential cascading effects on other organisms of deciduous forest ecosystems are discussed. We conclude that the present hunting practices that support overabundant ungulate populations constitute a major threat to the biodiversity of deciduous forests in Germany and Romania and to other places with similar ungulate management, and that changes my only be possible by modernizing the legal framework of hunting

Prevention of child mental health problems through parenting interventions in Southeastern Europe (RISE): study protocol for a multi-site randomised controlled trial

Background Childhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children’s future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting programmes are an effective way to alleviate them, although their outreach and scalability is still limited in LMICs. Methods/design A multi-site randomised controlled trial will be conducted in North Macedonia, Republic of Moldova and Romania to test the efficacy and cost-effectiveness of an optimised version of the promising Parenting for Lifelong Health Programme for Young Children (PLH-YC, 5 sessions), against a standard lecture on parenting issues (control group, 1 session). At least 864 participants who report having children between 2 and 9 years old who display elevated levels of behavioural difficulties will be randomised on a 1:1 basis to the intervention and control groups. The primary outcome will consist of parent report of child oppositional aggressive behaviour. Post-test (four months) and follow-up (12 months) assessments will provide information on short- and longer-term effects of PLH-YC compared to the parenting lecture in the control group. Discussion This randomised trial will test the efficacy of PLH-YC in alleviating child behavioural problems and assess the cost-effectiveness, transportability across three different cultural contexts, and potential for scalability of the programme